Health Policy Commons^™

Assisted Living, Residential Care, And Memory Care Staffing Level Dynamics: Oregon, 2017–2023, Sarah Dys, Ozcan Tunalilar

Institute on Aging Publications

Objectives

To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.

Design

Longitudinal study of licensed AL/RC communities.

Setting and Participants

A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.

Methods

Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social …

Journey To Well-Being: An Exploration Of Thrivership Post-Domestic Violence, Kader Gumus

Antioch University Dissertations & Theses

Domestic violence profoundly affects multiple facets of a survivor’s life. While most existing literature on survivorship addresses the immediate aftermath of domestic violence, this study delves into the extended process following the trauma of abuse to attain “thrivership,” a new concept in the scholarly and practice literature that emphasizes enduring well-being and flourishing. This dissertation examines the journeys from surviving to thriving for 13 women who transformed themselves and their lives to achieve well-being after traumatic domestic violence. Bronfenbrenner’s ecological systems theory was applied to examine the multiple layers of environmental influences on an individual’s development, including the micro, meso, …

In Danger: Hiv Vaccine Research And Development In Europe, Roger Tatoud, Yves Lévy, Roger Le Grand, Jose Alcami, Giorgio Barbareschi, Christian Brander, Andrea Cara, Behazine Combadière, François Dabis, Sarah Fidler, Tomáš Hanke, Carolina Herrera, Gunilla B. Karlsson Hedestam, Hester Kuipers, Sheena Mccormack, Christiane Moog, Giuseppe Pantaleo, Laura Richert, Rogier W. Sanders, Robin Shattock, Hendrik Streeck, Rodolphe Thiebaut, Alexandra Trkola, Klaus Üeberla, Marit J. Van Gills, Ralf Wagner, Winfried Weissenhorn, Yazdan Yazdanpanah, Gabriella Scarlatti, Jean Daniel Lelièvre

Department of Obstetrics & Gynecology Faculty Publications

Highly effective antiretroviral-based HIV prevention plays an important role in ending the global HIV/AIDS epidemic. However, the sustainable control of the epidemic is hampered by unequal access to prevention options, including HIV testing, alongside with drug resistance and ongoing barriers to accessing sustainable HIV treatment. Therefore, an HIV vaccine, combined with effective prevention and treatment, remains an absolute necessity to control the epidemic. Yet, the recent discontinuation of four major vaccine efficacy studies is raising concerns about the future of HIV vaccine research and development globally, and particularly in the European region where funding for vaccine research and development has …

Disparities In Cardiovascular Disease Outcomes And Economic Burdens Among Minorities In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf Alddin, Michael Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

Methods

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular …

Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.

METHODS:

This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects …

Politics In Public Health: Growing Partisan Divides In Covid-19 Vaccine Attitudes And Uptake Post-2021 Presidential Inauguration, Hongbin Fan, Zhongliang Zhou, Guanping Liu, Chi Shen, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives: To investigate whether the 2021 U.S. presidential inauguration contributed to a widening of partisan divides in COVID-19 vaccine attitudes and uptake. Methods: We leverage the presidential inauguration as a natural experiment and analyze data from the Household Pulse Survey and CDC vaccination records. Using a difference-in-differences framework with continuous treatment, we examine how the transition differentially affected state-level vaccine refusal rates and county-level vaccination rates, based on varying levels of partisanship as measured by the Trump-Biden vote gap. Results: Following Biden's inauguration, vaccine refusal declined more in pro-Biden states. Distrust in government and vaccines accounted for approximately 80% of …

Analyzing The Centers For Disease Control And Prevention Mortality Data Using Weekly Exceedance In Mortality Count And Weekly Change In Mortality Indicator: A Time Series Study, Aditya Chakraborty, Mohan D. Pant

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background and Aims

Cause-specific mortality (CSM) count prediction plays a vital role in the context of public health policy. In this study, we introduce a new analytical approach, which is divided into three phases to answer specific questions regarding CSM due to 14 specific causes by computing different simple, compound, and conditional probabilities.

Methods

A multivariate time series forecasting model was developed using the CDC weekly mortality count data. A binary data matrix was constructed for 14 causes of death (COD) as a function of weeks by combining the observed and forecasted mortalities. We introduced two new concepts: Weekly Exceedance …

The Affordable Care Act And The For-Profit Congregate Care Industry: How Good Policy Intent Turned A Fringe Industry Into A Taxpayer-Funded Multi Billion Dollar Industry, Erin Viehmann

College of Graduate Studies: Theses & Dissertations

The Affordable Care Act significantly transformed the for-profit congregate care (FPCC) industry, which provides residential treatment for adolescents with behavioral and mental health issues. This study analyzes financial records from Universal Health Services (UHS), the largest provider in the industry, to examine how healthcare policy changes and economic conditions affected the industry's growth and funding structure. Through analysis of SEC Form 10-K filings from 2006-2016, the research documents how the ACA's mental health coverage mandates created new revenue streams that enabled dramatic industry expansion. Findings show that following ACA passage in 2010, UHS more than doubled its behavioral health capacity …

Impact Of Volume-Based Procurement Policy On Coronary Stent Use In Tianjin: Interrupted Time Series Analysis, Zhao Yang, Liangyu Ni, Wei Zhao, Yuxi Li, Yongyi Wu, Qiyun Zhu, Linlin Da, Weijia Liu, Qi Zhang, Jianping Li, Bin Jiang

Health Behavior, Policy & Management Faculty Publications

Objectives

This study aimed to analyze the impact of China’s centralized volume-based procurement policy on the procurement and utilization of coronary stents in Tianjin from 2019 to 2021.

Methods

An interrupted time-series design was used to assess monthly procurement data of coronary stents and balloons in Tianjin from January 2019 to December 2021.

Results

The volume-based procurement policy significantly reduced coronary stents prices, with an average price reduction of 92.67% for ten selected stents, and the lowest price dropped to 469 CNY. Following policy implementation, annual procurement in Tianjin increased by 59.55%, and tertiary hospitals demonstrated a significant monthly level …

Examining Low-Income Caregivers' Knowledge And Comprehension Of The Dental Caries Process, Melissa Sullivan, Denise C. Mckinney, Deanne Shuman, Qi Zhang

Dental Hygiene Faculty Publications

Purpose Dental caries among young children remains a public health concern in the United States (US). Children of caregivers with low oral health literacy (OHL) tend to have greater unmet dental needs and poorer oral health status. The purpose of this study was to examine the understanding of pediatric dental terms associated with the dental caries process among low-income caregivers.

Methods This study included 14 caregivers with children enrolled in a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in the Southeastern US. Through structured phone interviews, the validated Oral Health Literacy Inventory for Parents (OH-LIP) was used …

A Qualitative Analysis Of College Students' Interest In Mhealth Solutions, Leslie Hoglund, Craig M. Becker, Cara Tonn

Health Behavior, Policy & Management Faculty Publications

This study explores college students' perceptions of an AI-driven mHealth application designed to promote well-being. With rising mental health challenges in academic settings, students increasingly seek digital tools that provide holistic support for physical, mental, and financial health. Through focus groups, this qualitative study examines students' preferences for personalized health tracking, educational content, and flexible reminders within a private, supportive community. Key findings emphasize students' desire for a balanced, all-in-one app that integrates health and wellness tools without overwhelming them with notifications. Students also highlighted the importance of social media integration for outreach, though concerns were raised about potential stress …

Pandemics And Partisanship: The Impact Of Political Identity On Public Health Responses, Andy Tuholski

Midwest Social Sciences Journal

This literature review examines the intersection of political partisanship and public health responses during pandemics, with a focus on the COVID-19 pandemic in the United States. Historically, pandemics such as the Venetian plague (1575-1577) and the Great Plague of London (1665-1666) have elicited responses driven by socioeconomic and health factors. In contrast, the COVID-19 pandemic in the U.S. was distinctly shaped by pre-existing political affiliations, particularly between conservative and liberal factions. Applying Social Identity Theory (SIT), this review explores how group identity and partisanship influenced pandemic-related behaviors and attitudes. Empirical evidence indicates that Republican-leaning states experienced higher COVID-19 mortality rates, …

Adolescent And Caregiver Preparation For Legal Changes At Age 18, Blanca Sanchez-Fournier, Jordyn Babla, Mary Majumder, Beth H Garland, Constance M Wiemann, Albert C Hergenroeder

Center for Medical Ethics and Health Policy Staff Publications

Background: Most adolescents with special healthcare needs (ASHCN) will assume legal responsibility for making decisions about their medical treatment at age 18. Simultaneously, parents or other legal representatives (Caregivers) will lose ASHCN medical record access. This study examined ASHCN and Caregiver knowledge of, satisfaction with, and suggestions for improvement in preparing for these changes.

Methods: Eighty-three dyads (18-year-old ASHCN and Caregivers) completed an assessment to evaluate their knowledge about changes in responsibility for decision making with a focus on consent, satisfaction with the preparation received, and recommendations for improved preparation. Descriptive statistics and mean comparisons were used. Responses to open-ended …

Impact Of Personalized Risk Scores On Shared Decision Making In Left Ventricular Assist Device Implantation: Findings From A Qualitative Study, Holland Kaplan, Kristin Kostick-Quenet, Benjamin Lang, Robert J Volk, Jennifer Blumenthal-Barby

Center for Medical Ethics and Health Policy Staff Publications

Objective: To assess stakeholders' perspectives on integrating personalized risk scores (PRS) into left ventricular assist device (LVAD) implantation decisions and how these perspectives might impact shared decision making (SDM).

Methods: We conducted 40 in-depth interviews with physicians, nurse coordinators, patients, and caregivers about integrating PRS into LVAD implantation decisions. A codebook was developed to identify thematic patterns, and quotations were consolidated for analysis. We used Thematic Content Analysis in MAXQDA software to identify themes by abstracting relevant quotes.

Results: Clinicians had varying preferences regarding PRS integration into LVAD decision making, while patients and caregivers preferred real-time discussions about PRS with …

Deep Brain Stimulation For Childhood Treatment-Resistant Obsessive-Compulsive Disorder: Mental Health Clinician Views On Candidacy Factors, Ilona Cenolli, Tiffany A Campbell, Natalie Dorfman, Meghan Hurley, Jared N Smith, Kristin Kostick-Quenet, Eric A Storch, Jennifer Blumenthal-Barby, Gabriel Lázaro-Muñoz

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.

Objectives: …

Talking About Suffering In The Intensive Care Unit, Brent M Kious, Judith B Vick, Peter A Ubel, Olivia Sutton, Jennifer Blumenthal-Barby, Christopher E Cox, Deepshikha Ashana

Center for Medical Ethics and Health Policy Staff Publications

Background: Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients' families.

Methods: We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012-2017 to look at how the term "suffering" and its variants were used. A coding guide was developed by consensus-oriented discussion …

A Worker's Struggle, Sakan Binte Imran, Shadman Mahmood Khan Pathan

Electrical & Computer Engineering Faculty Publications

[Introduction] The casualty department at Sir Salimullah Medical College Mitford Hospital was crowded, as it always was. The air smelled of antiseptics, and hurried footsteps echoed through the narrow corridors. It was another day of internship, and I had just finished checking on a patient when a nurse called me over.

“There’s a new case in Trauma. Factory worker. Severe hand injury.”

I hurried over and found a man sitting on the examination table. His face was pale, and his forehead was glistening with sweat. His right hand was wrapped in a blood-soaked cloth. His left hand trembled as he …

A Hybrid Cloud Data Lake Architecture Supporting The Integration Of Clinical And Genomics Data, Apollo Mcowiti, Heidi Dowst, Fei Zheng, Susan Hilsenbeck, Christopher Amos

Center for Medical Ethics and Health Policy Staff Publications

Objective: Cancer centers must quickly integrate clinical genomics data from different vendors for oncology operations and research. Clinical data warehouse architectures are costly to construct and brittle, and they are not readily amenable to the rapid changes in oncology research. We introduce a cost-effective hybrid cloud Data Lake architecture for storing clinical genomic data from different vendors, aiding both clinical and research workflows.

Methods: We created a Data Lake architecture based on the zone architecture, with four layers: ingestion, storage, transformation, and interaction. The layers are implemented with a hybrid cloud architecture. Rich metadata created from patient and genomic data …

Examining Treatment Options In Youth With Major Depressive Disorder: Observations From The Tx-Ydsrn Registry Study, Emine Rabia Ayvaci, Karabi Nandy, Ryan Becker, Laura Stone, Abu Minhajuddin, Holli Slater, Lynnel C Goodman, Sarah M Wakefield, Eric A Storch, Joseph C Blader, Cesar A Soutullo, Graham J Emslie, Madhukar H Trivedi

Center for Medical Ethics and Health Policy Staff Publications

Objective: Treatment decisions for depression are a complex process, influenced by factors such as clinical characteristics, socioeconomic factors, and patient/caregiver preferences. This study examines the characteristics of treatment options during the first month of enrollment among depressed youth.

Methods: Data for 646 depressed youth were extracted from the Texas Youth Depression and Suicide Research Network study. Participants' treatments during the first month were categorized as no treatment (NT), psychotherapy only (THER), pharmacotherapy only (MED), or a combination of psychotherapy and pharmacotherapy (COMB). Sociodemographic and clinical features were compared across these treatment types.

Results: 7% were on NT, 5% on THER, …

A Landscape Analysis Of Psychedelic Retreat Organizations Advertising Online, Logan Neitzke-Spruill, Caroline S Beit, Jill Oliver Robinson, Nikita Singh, Srijith Kambala, Rishi Ramesh, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Research into psychedelics' clinical potential has corresponded to a growth in public interest and adult use. One common pathway to accessing psychedelics is through psychedelic retreats. While individual retreats have been characterized in the anthropological literature, no systematic evaluation of the psychedelic retreat industry exists. Assessing the characteristics of the psychedelic retreat industry is critical to understanding the associated ethical, legal, and social implications and ensuring consumer safety. To this end, we conducted a landscape analysis of online, publicly available information to capture and characterize a broad range of organizations offering psychedelic retreats and marketing to English-speaking consumers. From July …